| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,806 |
3,729 |
$537K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
5,136 |
3,126 |
$479K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
6,539 |
2,085 |
$439K |
| D1120 |
Prophylaxis - child |
6,295 |
6,235 |
$270K |
| D2394 |
|
2,100 |
1,298 |
$237K |
| D0120 |
Periodic oral evaluation - established patient |
9,168 |
8,936 |
$236K |
| D0274 |
Bitewings - four radiographic images |
6,910 |
6,686 |
$234K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,222 |
5,109 |
$216K |
| D1110 |
Prophylaxis - adult |
6,063 |
5,780 |
$202K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,091 |
1,724 |
$197K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,119 |
7,024 |
$181K |
| D0210 |
Intraoral - complete series of radiographic images |
2,989 |
2,865 |
$156K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
254 |
191 |
$145K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,110 |
589 |
$129K |
| D7250 |
|
692 |
227 |
$86K |
| D0140 |
Limited oral evaluation - problem focused |
2,970 |
2,851 |
$83K |
| D2335 |
|
566 |
303 |
$65K |
| D2332 |
|
668 |
406 |
$65K |
| D0220 |
Intraoral - periapical first radiographic image |
3,825 |
3,687 |
$42K |
| D1351 |
Sealant - per tooth |
1,114 |
339 |
$40K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
436 |
246 |
$24K |
| D2160 |
|
191 |
132 |
$14K |
| D2330 |
|
186 |
112 |
$11K |
| D2140 |
|
225 |
117 |
$10K |
| D5110 |
|
18 |
12 |
$8K |
| D0330 |
Panoramic radiographic image |
288 |
157 |
$8K |
| D2161 |
|
65 |
40 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
189 |
93 |
$5K |
| D2954 |
|
38 |
25 |
$4K |
| D0272 |
Bitewings - two radiographic images |
51 |
50 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
130 |
109 |
$1K |